<?php
JHtml::_('behavior.formvalidation');
?>
<h1>Call back request</h1>
<h2>Call back request</h2>
<p><span class="testoj"><br /> <strong>Welcome to our callback form.</strong> <br /> <br /> <strong>We call you back when it suits  you.</strong> </span></p>
<p><span class="testoj">Please ensure the personal details you enter in each field are correct  before you submit. <strong>*Required  fields</strong> Please include your FULL  phone number including the area code. If you are located outside of the UK,  please include your international dialling code.<br /> <br /> <br /> </span></p>
<form id="contatti" method="post" action="<?php echo JRoute::_('index.php?option=com_onestop&task=sendmail.request'); ?>" class="form-validate"> 
<input id="request" name="request" type="hidden" value="request" /> 
<table class="testo" border="0" cellspacing="0" cellpadding="4" width="100%">
<tbody>
<tr>
<td>Name:</td>
<td><input id="name" class="testo required" name="name" type="text" /></td>
<td>Surname:</td>
<td><input id="surname" class="testo required" name="surname" type="text" /></td>
</tr>
<tr>
<td>Phone:</td>
<td><input id="phone" class="testo " name="phone" type="text" /></td>
<td>Email:</td>
<td><input id="email" class="testo required email" name="email" type="text" /></td>
</tr>
<tr>
<td>Reference:</td>
<td><input id="subject" class="testo required" name="subject" type="text" /></td>
<td>Request:</td>
<td><textarea id="message" class="testo required" cols="30" rows="4" name="message"></textarea></td>
</tr>
<tr>
<td>Call back in:</td>
<td><select id="callback_in" name="callback_in"> <option value="10 Minutes">10 Minutes</option> <option selected="selected" value="20 Minutes">20 Minutes</option> <option value="30 Minutes">30 Minutes</option> <option value="60 Minutes">60 Minutes</option> <option value="Tomorrow">Tomorrow</option> </select></td>
<td class="testo11" colspan="2"><br /> <br /></td>
</tr>
<tr>
<td>Captcha code</td>
<td class="testo11">
<div id="captchaimage"><img src="index.php?option=com_kcaptcha&view=kcaptcha&<?php echo session_name()?>=<?php echo session_id(); ?>" border="0" alt="Captcha image" /></div>
<br /></td>
<td class="testo11" colspan="2"><br /> Verification: <input id="captcha" class="required captcha" maxlength="6" name="captcha" size="6" type="text" /> <br /></td>
</tr>
<tr>
<td class="testo_11" colspan="4">
<p><span><strong>Privacy Policy </strong><br /></span> <a class="testo_11" href="images/privacy_policy.pdf" target="_blank"><em><span style="text-decoration: underline;">At  One Stop Language Solutions we are committed to protecting your data and  privacy...</span></em><img src="images/pdf.png" border="0" width="20" height="20" align="absmiddle" /></a></p>
</td>
</tr>
<tr>
<td colspan="4"><input id="privacy" class="required" name="privacy" type="checkbox" /> I agree to the terms and conditions</td>
</tr>
<tr>
<td colspan="4" align="center">
	<button class="button validate" type="submit"><img src="<?php echo JURI::base(); ?>/images/senddata2.png" /></button>
	<input type="hidden" name="mail" value="request">
</td>
</tr>
</tbody>
</table>
</form>